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STREETTREE
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I, C 4—5 �40?5
, Owner/Aent for
A (PLEASE PRINT) g �� �`� '�
(PERMIT HOLDER)
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A Do hereb � rt�y that the following location
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A meets City Of Tigard/Washington County _►
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A land use and development standards for street tree installation.
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A ADDRESS: ►
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1 LOT: Fa �ae�c,1b ,d PSL SUBDIVISION: (&t4c� Pray 14-
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BY: a,...1 .,..f DATE: q(6 /02—
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RECEIVED BY: DATE: